Evaluation of point-of-care blood glucose measurements in patients with diabetic ketoacidosis or hyperglycemic hyperosmolar syndrome admitted to a critical care unit

Dawn E. Corl, Tom S. Yin, Michelle E. Mills, Tina L. Spencer, Lucy Greenfield, Erin Beauchemin, Jessica Cochran, Louise D. Suhr, Rachel E Thompson, Brent E. Wisse

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Background: Point-of-care (POC) blood glucose (BG) measurement is currently not recommended in the treatment of patients presenting with diabetic ketoacidosis (DKA) or hyperglycemic hyperosmolar syndrome (HHS). Methods: We prospectively evaluated and compared capillary and venous POC BG values with laboratory venous glucose in patients with DKA or HHS admitted to one critical care unit over 8 months. Results: Venous laboratory glucose was strongly correlated with venous (r = 0.98) and capillary (r = 0.96) POC glucose values, though POC glucose values were higher than venous laboratory values (venous POC 21 ± 3 mg/dl, capillary POC 30 ± 4 mg/dl; both p < .001). Increased plasma osmolality had no efect on glucose meter error, while acidemia (pH < 7.3) was associated with greater glucose meter error (p = .04) independent of glucose levels. Comparing hypothetical insulin infusion rates based on laboratory venous glucose to actual infusion rates based on POC glucose values showed that 33/61 insulin infusion rates would have been unchanged, while 28 out of 61 rates were on average 7% ± 2% higher. There were no instances of hypoglycemia in any of the patients. Conclusions: Overall, both venous and capillary POC BG values were safe for the purpose of titrating insulin infusions in patients with severe hyperglycemia. Acidemia, but not hyperosmolality, increased POC BG value errors.

Original languageEnglish (US)
Pages (from-to)1265-1274
Number of pages10
JournalJournal of Diabetes Science and Technology
Volume7
Issue number5
DOIs
StatePublished - Jan 1 2013

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Hyperglycemic Hyperosmolar Nonketotic Coma
Point-of-Care Systems
Diabetic Ketoacidosis
Critical Care
Glucose
Blood Glucose
Blood
Insulin
Hypoglycemia
Hyperglycemia
Osmolar Concentration

Keywords

  • Accuracy
  • Blood glucose
  • Hyperglycemic hyperosmolar syndrome
  • Ketoacidosis
  • Point of care

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Bioengineering
  • Biomedical Engineering

Cite this

Evaluation of point-of-care blood glucose measurements in patients with diabetic ketoacidosis or hyperglycemic hyperosmolar syndrome admitted to a critical care unit. / Corl, Dawn E.; Yin, Tom S.; Mills, Michelle E.; Spencer, Tina L.; Greenfield, Lucy; Beauchemin, Erin; Cochran, Jessica; Suhr, Louise D.; Thompson, Rachel E; Wisse, Brent E.

In: Journal of Diabetes Science and Technology, Vol. 7, No. 5, 01.01.2013, p. 1265-1274.

Research output: Contribution to journalArticle

Corl, Dawn E. ; Yin, Tom S. ; Mills, Michelle E. ; Spencer, Tina L. ; Greenfield, Lucy ; Beauchemin, Erin ; Cochran, Jessica ; Suhr, Louise D. ; Thompson, Rachel E ; Wisse, Brent E. / Evaluation of point-of-care blood glucose measurements in patients with diabetic ketoacidosis or hyperglycemic hyperosmolar syndrome admitted to a critical care unit. In: Journal of Diabetes Science and Technology. 2013 ; Vol. 7, No. 5. pp. 1265-1274.
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AU - Yin, Tom S.

AU - Mills, Michelle E.

AU - Spencer, Tina L.

AU - Greenfield, Lucy

AU - Beauchemin, Erin

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AU - Thompson, Rachel E

AU - Wisse, Brent E.

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N2 - Background: Point-of-care (POC) blood glucose (BG) measurement is currently not recommended in the treatment of patients presenting with diabetic ketoacidosis (DKA) or hyperglycemic hyperosmolar syndrome (HHS). Methods: We prospectively evaluated and compared capillary and venous POC BG values with laboratory venous glucose in patients with DKA or HHS admitted to one critical care unit over 8 months. Results: Venous laboratory glucose was strongly correlated with venous (r = 0.98) and capillary (r = 0.96) POC glucose values, though POC glucose values were higher than venous laboratory values (venous POC 21 ± 3 mg/dl, capillary POC 30 ± 4 mg/dl; both p < .001). Increased plasma osmolality had no efect on glucose meter error, while acidemia (pH < 7.3) was associated with greater glucose meter error (p = .04) independent of glucose levels. Comparing hypothetical insulin infusion rates based on laboratory venous glucose to actual infusion rates based on POC glucose values showed that 33/61 insulin infusion rates would have been unchanged, while 28 out of 61 rates were on average 7% ± 2% higher. There were no instances of hypoglycemia in any of the patients. Conclusions: Overall, both venous and capillary POC BG values were safe for the purpose of titrating insulin infusions in patients with severe hyperglycemia. Acidemia, but not hyperosmolality, increased POC BG value errors.

AB - Background: Point-of-care (POC) blood glucose (BG) measurement is currently not recommended in the treatment of patients presenting with diabetic ketoacidosis (DKA) or hyperglycemic hyperosmolar syndrome (HHS). Methods: We prospectively evaluated and compared capillary and venous POC BG values with laboratory venous glucose in patients with DKA or HHS admitted to one critical care unit over 8 months. Results: Venous laboratory glucose was strongly correlated with venous (r = 0.98) and capillary (r = 0.96) POC glucose values, though POC glucose values were higher than venous laboratory values (venous POC 21 ± 3 mg/dl, capillary POC 30 ± 4 mg/dl; both p < .001). Increased plasma osmolality had no efect on glucose meter error, while acidemia (pH < 7.3) was associated with greater glucose meter error (p = .04) independent of glucose levels. Comparing hypothetical insulin infusion rates based on laboratory venous glucose to actual infusion rates based on POC glucose values showed that 33/61 insulin infusion rates would have been unchanged, while 28 out of 61 rates were on average 7% ± 2% higher. There were no instances of hypoglycemia in any of the patients. Conclusions: Overall, both venous and capillary POC BG values were safe for the purpose of titrating insulin infusions in patients with severe hyperglycemia. Acidemia, but not hyperosmolality, increased POC BG value errors.

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